February 7, 2023
CMS releases Final Rule on audit methodology and related policies for the MA Risk Adjustment Data Validation (RADV) program
On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published this Final Rule (CMS 2023-01942) in the Federal Register. This final rule announces certain policies to improve program integrity and payment accuracy in the Medicare Advantage (MA) program. The purpose of this final rule is to outline the CMS audit methodology and related policies for the MA Risk Adjustment Data Validation (RADV) program. Specifically, this final rule codifies in regulation that, as part of the RADV audit methodology, CMS will extrapolate RADV audit findings beginning with payment year (PY) 2018 and will not extrapolate RADV audit findings for PYs 2011 through 2017. CMS is also finalizing a policy whereby CMS will not apply an adjustment factor (known as a Fee-For-Service (FFS) Adjuster) in RADV audits. CMS is also codifying in regulation the requirement that MA organizations (MAOs) remit improper payments identified during RADV audits in a manner specified by CMS.
The final rule is effective on April 3, 2023.
BluePeak has created an index to the proposed rule, along with a highlight of its most significant provisions. Click here to review.